匀速步行运动对2型糖尿病患者血压及血糖、血脂代谢的影响

目的:观察匀速步行运动方式对糖尿病患者生物学和血生化指标的影响,探讨该干预方法的有效性。方法:2000-05/2002-10汕头市澄海区人民医院门诊就诊或住院治疗的糖尿病患者127例。符合纳入标准糖尿病患者82例,根据自愿原则分为步行运动组40例(男25例,女15例)和对照组42例(男26例,女16例。步行运动组:采用匀速平路步行锻炼方式。对照组:只给予常)规治疗,未参加锻炼。锻炼组治疗前后,对照组首次检查后6个月进行生物学指标(体质量、体质量指数、腰围、腰臀比、收缩压、舒张压、静息心率)和血生化指标犤空腹血糖、葡萄糖负荷试验2h后血糖、糖化血红蛋白(HbA1c)、血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇(highdensitylipoproteincholesterol,HDL-C)、低密度脂蛋白胆固醇(lowdensitylipoproteincholesterol,LDL-C)犦。结果:两组患者首次检查生物学和血生化各项指标分布接近(P均>0.05)。运动步行组患者治疗后的体质量犤(75.5±19.6)kg犦,体质量指数犤(25.0±8.2)kg/m犦,腰围犤(83.5±22.7)cm犦,腰臀比(0.892±0.04),收缩压犤(137.4±22.7)mmHg犦,空腹血糖犤(6.62±1.29)mmol/L,葡萄糖负荷2h后血糖犦犤(9.29±1.88)mmol/L,犦HbA1c犤(5.59±0.40)%,TC犦犤(5.41±0.75)mmol/L,三酰甘油犦犤(2.03±0.30)mmol/L,HD     

Use of sibutramine in overweight adult hispanic patients with type 2 diabetes mellitus: a 12-month, randomized, double-blind, placebo-controlled clinical trial

BACKGROUND: The management of type 2 diabetes mellitus is complicated by the presence of risk factors related to overweight and obesity, particularly visceral adiposity. However, weight loss and weight maintenance are difficult for patients with diabetes, and the benefits of dietary modifications are typically modest. Sibutramine is a serotonin- and norepinephrine-reuptake inhibitor that reduces food intake by inducing early satiety and attenuates the decrease in basal energy expenditure associated with weight loss. Previous trials of sibutramine in overweight and obese patients with type 2 diabetes have shown significant weight loss accompanied by better glycemic control. OBJECTIVE: The goal of this study was to assess the effect on body weight and glycemic control of sibutramine in combination with glibenclamide in obese Hispanic patients with type 2 diabetes. METHODS: This was a 12-month, randomized, double-blind, placebo-controlled clinical trial conducted at the Endocrinology Service, General Hospital of Mexico, Mexico City. Included were overweight or obese (body mass index [BMI] >27 kg/M2) patients with type 2 diabetes between the ages of 24 and 65 years who had been receiving glibenclamide monotherapy for at least 2 weeks and whose glucose concentrations were stable. Patients were randomized to receive sibutramine 10 mg or placebo once daily. The primary efficacy measures were change in body weight, waist circumference, and glycosylated hemoglobin (HbA1c). Anthropometrics and fasting glucose concentrations were measured monthly. HbA1c was determined at baseline and at 6 and 12 months. Laboratory parameters were measured at baseline and at the end of the study. RESULTS: Forty-four patients were randomized to receive sibutramine (28 women, 16 men; mean [SD] age, 47.6 [9.0] years), and 42 were randomized to receive placebo (31 women, 11 men; mean age, 45.8 [8.1] years). Twenty-four patients in the sibutramine group and 23 in the placebo group completed the trial. In the sibutramine group, body weight was reduced from a mean (SD) of 73.9 (10.3) kg at baseline to 69.8 (10.6) kg at month 12; BMI decreased from 29.9 (2.6) to 28.2 (2.9) kg/M2; waist circumference was reduced from 94.9 (8.4) to 90.8 (8.4) cm; the plasma fasting glucose concentration decreased from 140.4 (29.4) to 114.2 (32.0) mg/dL; and the HbA1c value was reduced from 8.9% (1.2) to 8.3% (1.2) (all, P < 0.001). In the placebo group, the corresponding changes were from 74.5 (10.3) kg at baseline to 73.1 (11.2) kg at month 12; from 30.1 (2.5) to 29.5 (2.9) kg/M2; from 94.4 (7.3) to 93.1 (8.3) cm (P < 0.05); from 140.7 (25.2) to 123.9 (38.3) mg/dL (P < 0.05); and from 9.0% (1.2) to 9.1% (1.3). In the sibutramine group, weight loss continued for up to 12 months. CONCLUSION: In this population of obese Hispanic patients with type 2 diabetes, sibutramine combined with glibenclamide therapy achieved weight loss for up to 12 months and was associated with better glycemic control than placebo.     

Metabolic and antihypertensive effects of moxonidine and moxonidine plus irbesartan in patients with type 2 diabetes mellitus and mild hypertension: a sequential, randomized, double-blind clinical trial

BACKGROUND: The autonomic nervous system plays an important part in the homeostasis of blood pressure (BP), and sympathetic overactivity may contribute to metabolic conditions such as glycemic intolerance or insulin resistance. OBJECTIVE: This study evaluated the anti-hypertensive and metabolic effects of moxonidine, a selective imidazoline II-receptor agonist that lowers BP by central inhibition of the sympathetic nervous system, and moxonidine plus the angiotensin II-receptor blocker irbesartan in patients with type 2 diabetes mellitus and mild hypertension. METHODS: This was a study in patients with type 2 diabetes previously untreated with medication and untreated mild hypertension (diastolic blood pressure [DBP] >90 and <105 mm Hg). For the first 3 months of the study, all patients were treated for hypertension with moxonidine 0.2 mg once daily (M0.2) to establish a moxonidine baseline. After this single-arm period, patients were randomized to receive double-blind treatment with moxonidine 0.2 mg BID (M0.4) or moxonidine 0.2 mg plus irbesartan 150 mg (M0.2+1) once daily for 3 months. Changes in DBP, systolic blood pressure (SBP), body mass index (BMI), fasting and postprandial plasma glucose (FPG and PPG), fasting and postprandial plasma insulin (FPI and PPI), glycosylated hemoglobin (HbA(1c)), Homeostasis Model Assessment of insulin sensitivity (HOMA-S), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were evaluated at baseline, 3 months (end of single arm period), and 6 months (end of randomized treatment period). RESULTS: The study enrolled 99 patients (50 men, 49 women; mean [SD] age, 55 [7] years; mean BMI, 26.8 [0.9]). No significant changes in BMI, PPG, PPI, TC, or LDL-C were observed over the entire study period. At 3 months, treatment with M0.2 was associated with significant improvements from baseline in SBP and DBP (P < 0.05), whereas there were no significant changes in HbA(1c), FPG, FPI, HOMA-S, HDL-C, or TG. At 6 months, significant decreases from baseline in HbA(1c), FPG, FPI, HOMA-S, and TG were observed in the M0.4 group (all, P < 0.05), but not in the M0.2+1 group. The M0.4 group also had a significant increase from baseline in HDL-C (P < 0.05) that was not seen in the M0.2+1 group. The changes in FPI and HOMA-S were significantly greater in the M0.4 group compared with the M0.2+1 group (P < 0.05). Significant decreases from baseline in SBP and DBP were observed in both the M0.4 and M0.2+1 groups (P < 0.02 and P < 0.01, respectively). No patient withdrew from the study because of a drug-related adverse event, and there were no clinically significant drug-related changes in laboratory values during the study. CONCLUSION: In these patients with type 2 diabetes and mild hypertension, the M0.4 group had greater improvements in measures of glucose metabolism and the plasma lipid profile compared with those treated with M0.2+1.     

Insulin-like growth factor-I improves glucose and lipid metabolism in type 2 diabetes mellitus.

Hyperglycemia, hyperinsulinemia, and insulin resistance cause vascular disease in type 2 diabetes mellitus. Dietary treatment alone often fails and oral drugs or insulin enhance hyperinsulinemia. In previous studies, an intravenous bolus of recombinant human insulin-like growth factor-I (rhIGF-I) caused normoglycemia in insulin-resistant diabetics whereas rhIGF-I infusions lowered insulin and lipid levels in healthy humans, suggesting that rhIGF-I is effective in insulin-resistant states. Thus, eight type 2 diabetics on a diet received on five treatment days subcutaneous rhIGF-I (2 x 120 micrograms/kg) after five control days. Fasting and postprandial glucose, insulin, C-peptide, proinsulin, glucagon, triglyceride, insulin-like growth factor-I and -II, and growth hormone levels were determined. RhIGF-I administration increased total IGF-I serum levels 5.3-fold above control. During the control period mean (+/- SD) fasting glucose, insulin, C-peptide, and total triglyceride levels were 11.0 +/- 4.3 mmol/liter, 108 +/- 50 pmol/liter, 793 +/- 250 pmol/liter, and 3.1 +/- 2.7 mmol/liter, respectively, and decreased during treatment to a nadir of 6.6 +/- 2.5 mmol/liter, 47 +/- 18 pmol/liter, 311 +/- 165 pmol/liter, and 1.6 +/- 0.8 mmol/liter (P < 0.01), respectively. Postprandial areas under the glucose, insulin, and C-peptide curve decreased to 77 +/- 13 (P < 0.02), 52 +/- 11, and 60 +/- 9% (P < 0.01) of control, respectively. RhIGF-I decreased the proinsulin/insulin ratio whereas glucagon levels remained unchanged. The magnitude of the effects of rhIGF-I correlated with the respective control levels. Since rhIGF-I appears to improve insulin sensitivity directly and/or indirectly, it may become an interesting tool in type 2 diabetes and other states associated with insulin resistance.     

延续护理对初发2型糖尿病病人血糖、血脂、血压及自我管理能力的影响

[目的]应用延续护理服务模式提高初发2型糖尿病病人自我管理能力及相关控制指标达标率。[方法]将2014年1月—20年9月在内分泌科住院新诊断2型糖尿病合并高血压、血脂异常的92例病人随机分为观察组和对照组,各46例。观察组实施延护理服务模式,出院1个月内每周电话回访1次,之后2个月每2周回访1次,4个月~6个月每月回访1次,了解病人饮食控制、糖监测及药物治疗情况,给予个体化健康指导,指导病人监测并记录血糖、血压、体重变化。对照组采用常规方法于出院后第1周1个月之内回访病人,提示病人按时治疗、及时监测、参加糖尿病教育。6个月后评估两组病人血糖、血脂、血压、体重等糖尿病相指标控制情况,并采用2型糖尿病自我管理行为量表(2-DSCS)测评两组病人自我管理能力。[结果]6个月后两组糖尿病病人相指标控制达标情况、自我管理能力比较差异均有统计学意义(P0.05或P0.01)。[结论]延续护理可提高初发2型糖尿病病的自我管理能力,更好地控制相关指标,预防并发症的发生,提高病人的生活质量。     

运动疗法干预2型糖尿病患者血糖血脂的变化

目的:观察运动疗法对2型糖尿病患者血糖、血脂的干预效果,并观察起效时间。方法:选择2005-03/09攀枝花市中西医结合医院收治的2型糖尿病患者56例。所有患者进行运动治疗,运动方案包括热身活动、运动锻炼(包括任何可以活动全身的运动,特别是腿部的运动和抗阻力运动)和放松活动,根据患者的年龄、体质、有无并发症来决定其运动强度和运动方式,同时密切观察运动时的反应,运动频率每周5～7次,不低于3次。分别于运动前和运动后第2,4,6,8周,检测其血糖、总胆固醇和三酰甘油的变化。结果:56例全部进入结果分析。①空腹血糖:运动后2周即显著低于运动前,运动后4周低于运动后2周(P<0.05)。②2h餐后血糖:运动后2周显著低于运动前(P<0.01)。③总胆固醇:运动后2周即显著低于运动前,运动后4周低于运动后2周(P<0.05)。④三酰甘油:运动后2周显著低于运动前(P<0.01)。结论:运动疗法可以明显改善2型糖尿病患者的血糖、血脂水平,其疗效大约发生在运动后两周左右。     

Long-term effects of glimepiride or rosiglitazone in combination with metformin on blood pressure control in type 2 diabetic patients affected by the metabolic syndrome: a 12-month, double-blind, randomized clinical trial

BACKGROUND: Some evidence suggests that antihyperglycemic drugs might have a small but clinically significant beneficial effect on blood pressure in patients with diabetes mellitus. Based on a literature search, few direct comparisons of different antihyperglycemic treatments on blood pressure have been reported. OBJECTIVES: The primary aim of the present study was to compare the effect of long-term (12-month) combination treatment with glimepiride or rosiglitazone plus metformin on blood pressure in patients with type 2 diabetes mellitus (DM-2) and the metabolic syndrome. Secondary end points were glycemic control and improvement in insulin sensitivity. METHODS: This randomized, double-blind study was conducted at 2 centers in Italy. Patients aged > or =18 years with DM-2 and the metabolic syndrome and poor glycemic control (insulin resistance) with monotherapy with the maximum tolerated dose of an antihyperglycemic agent (eg, a sulfonylurea, metformin) were enrolled. All patients received 12 months of oral treatment with metformin 500 mg TID plus glimepiride 2 mg QD (G + M) or rosiglitazone 4 mg QD (R + M). Blood pressure, heart rate (HR), and body mass index (BMI); plasma levels of fasting and postprandial glucose and insulin (FPG, PPG, FPI, and PPI, respectively) and glycosylated hemoglobin (HbA(1c)); and homeostasis model assessment (HOMA) index were determined at 0 (baseline), 3, 6, 9, and 12 months of treatment. Adverse effects (AEs) were assessed using spontaneous reporting, patient interview, and laboratory analysis. RESULTS: Ninety-nine patients were enrolled in the study; 95 completed it (48 men, 47 women; mean age, 54 years [range, 47-58 years]; G + M, 47 patients; R + M, 48 patients). Four patients did not complete the study due to noncompliance (2 patients in the R + M group), protocol violation (1 patient in the G + M group), and loss to follow-up (1 patient in the G + M group). Mean blood pressure values were not significantly improved in the G + M group at any time point, whereas these values were significantly improved at 12 months in the R + M group. Mean BMI, HbA(1c), FPG, and PPG were significantly decreased from baseline in both groups at 12 months (all, P < or = 0.05). Mean FPI, PPI, and HOMA index were significantly improved at 12 months only in the R + M group (all, P < or = 0.05 vs baseline); these changes were not found in the G + M group. No significant changes in HR were found. Headache and flatulence were reported in both groups (G + M, 2 patients each; R + M, 1 and 2 patients, respectively), but these AEs were mild and transient. In the R + M group, liver enzyme levels were increased to 1.5-fold the upper limit of normal in 3 patients, but were normalized by study end. CONCLUSIONS: In this study in patients with DM-2 and the metabolic syndrome, long-term (12-month) combination treatment with R + M, but not G + M, was associated with a significant improvement in blood pressure control. Improvements in glycemic control and insulin resistance-related parameters were found at 9 months with R + M, compared with 12 months with G + M. Both treatments were well tolerated.     

运动疗法干预2型糖尿病患者血糖血脂的变化

目的：观察运动疗法对2型糖尿病患者血糖、血脂的干预效果，并观察起效时间。 方法：选择2005-03／09攀枝花市中西医结合医院收治的2型糖尿病患者56例。所有患者进行运动治疗，运动方案包括热身活动、运动锻炼（包括任何可以活动全身的运动，特别是腿部的运动和抗阻力运动）和放松活动，根据患者的年龄、体质、有无并发症来决定其运动强度和运动方式，同时密切观察运动时的反应，运动频率每周5—7次，不低于3次。分别于运动前和运动后第2，4，6，8周，检测其血糖、总胆固醇和三酰甘油的变化。 结果：56例全部进入结果分析。①空腹血糖：运动后2周即显著低于运动前，运动后4周低于运动后2周（P〈0．05）。②2h餐后血糖：运动后2周显著低于运动前（P〈0．01）。③总胆固醇：运动后2周即显著低于运动前，运动后4周低于运动后2周（P〈0．05）。④三酰甘油：运动后2周显著低于运动前（P〈0．01）。 结论：运动疗法可以明显改善2型糖尿病患者的血糖、血脂水平，其疗效大约发生在运动后两周左右。     

Blood pressure control in patients with mild to moderate essential hypertension switched from nifedipine gastrointestinal therapeutic system (GITS) 30 mg to nifedipine GITS 20 mg

BACKGROUND: Nifedipine gastrointestinal therapeutic system (GITS) is a once-daily formulation of nifedipine that provides sustained plasma nifedipine concentrations throughout the 24-hour dosing interval. OBJECTIVE: This study was undertaken to determine if adult patients with mild to moderate essential hypertension whose blood pressure had been controlled for > or = 3 months with nifedipine GITS 30 mg could be successfully switched to a 20-mg daily dose with continued antihypertensive efficacy. METHODS: This was a randomized, double-blind, parallel-group study. Patients entered a 1-week run-in period during which they continued to receive their usual antihypertensive medication, including nifedipine GITS 30 mg. After baseline assessment, patients entered a 6-week treatment period during which they were randomly assigned to receive nifedipine GITS 30 or 20 mg. Men and women were eligible to participate if they were > or = 55 years of age, had received a diagnosis of mild to moderate essential hypertension (sitting diastolic blood pressure [DBP] 95-114 mm Hg), and had exhibited good blood pressure control (sitting DBP < or = 90 mm Hg) while taking nifedipine GITS 30 mg once daily for > or = 3 months. Systolic blood pressure (SBP), DBP, and heart rate were recorded at baseline and after 1, 3, and 6 weeks of treatment. Adverse events were reported by patients. The responder rate was defined as the percentage of patients whose sitting DBP was < 95 mm Hg at the final study assessment. Results were based on the intent-to-treat analyses, which included data for all patients who received > or = 1 dose and had 1 postbaseline blood pressure assessment. Statistical significance was set at P < 0.05. RESULTS: Seventy-five patients entered the 1-week run-in period; 71 patients (94.7%) were randomized to treatment. Twenty-four patients received nifedipine GITS 30 mg for 43.0 +/- 3.3 days, and 47 patients received nifedipine GITS 20 mg for 42.5 +/- 6.7 days. Both groups exhibited a sustained decrease in blood pressure throughout the study; minor variations were not statistically significant. End-point SBP and DBP for the 30- and 20-mg groups were 135.5 +/- 9.8/81.7 +/- 5.4 mm Hg and 138.6 +/- 11.8/82.9 +/- 7.6 mm Hg, respectively. Changes from baseline in end-point SBP and DBP did not differ significantly between groups. At the end of treatment, goal DBP (< 95 mm Hg) was achieved by 24 of 24 patients (100%) receiving the 30-mg dose and 45 of 47 patients (95.7%) receiving the 20-mg dose. Blood pressure control (sitting DBP < 90 mm Hg) was achieved by 21 of 24 (87.5%) patients in the 30-mg group and 35 of 47 (74.5%) patients in the 20-mg group. The most commonly reported adverse event was headache; 2 patients discontinued the study because of adverse events. Overall, 9 of 24 patients (37.5%) in the 30-mg group and 14 of 47 patients (29.8%) in the 20-mg group experienced > or = 1 treatment-related adverse event. CONCLUSIONS: Patients whose mild to moderate essential hypertension is controlled with nifedipine GITS 30 mg once daily may be able to switch to 20 mg once daily with continued antihypertensive efficacy. In addition to safety and economic advantages, such a switch may be a reasonable alternative in patients with lower body weight or as an adjunct to existing antihypertensive therapy.     

2型糖尿病患者血清抵抗素 血糖和血脂水平比较

目的比较研究2型糖尿病患者血清抵抗素浓度与空腹血糖、血脂代谢水平。方法选择50例2型糖尿病患者和50例健康中老年人,分别为糖尿病组和对照组,用竞争性酶联免疫吸附法测定各组空腹血浆抵抗素水平,同时检测空腹血糖、血脂各项指标。结果糖尿病空腹血浆抵抗素水平高于对照组,差异有统计学意义（P〈0．05）。结论血清抵抗素水平与2型糖尿病关系密切,抵抗素水平可能影响体内能量代谢和平衡,与糖代谢、脂代谢的关系更为密切。     

Reclid effects on carbohydrate, lipid metabolism, lipid peroxidation and hemodynamics in patients with diabetes mellitus type 2

Patients with diabetes mellitus type II have disorders in carbohydrate, lipid and other kinds of metabolism. This increases the risk of cardiovascular complications and atherogenesis. Therefore, it is advisable to use drugs preventing an excessive late phase of insulin secretion with resultant reduction of hyperinsulinemia. Reclid, the drug of this group, improves metabolic processes, insulin resistance, lipid metabolism, hemostasis and microcirculation. 3-month reclid therapy of patients with non-insulin-dependent diabetes mellitus produced a good hypoglycemic effect in 85% of the cases. This effect consisted in reduction of basal and postprandial glycemia, levels of glycosylated hemoglobin, 24-h glucosuria. In patients with diabetes mellitus type II reclid diminished the levels of total cholesterol, triglycerides, glycosylated hemoglobin. In patients with left ventricular diastolic dysfunction, reclid improved transmitral blood flow. Thus, reclid provides a good metabolic control in patients with non-insulin-dependent diabetes mellitus. Moreover, it positively affects mechanisms initiating cardiovascular complications in diabetic patients.     

不同胰岛素强化方法治疗2型糖尿病疗效比较

目的比较胰岛素泵和胰岛素笔在2型糖尿病强化治疗中对糖脂代谢的影响。方法将2型糖尿病患者随机分成阅绀,胰岛素泵组（A组）的患者采用胰岛素泵治疗,胰岛素笔组（B组）患者采用胰岛素笔治疗。监测两组患者治疗前后血糖、血清胆固醇、甘油三酯的变化,并比较血糖达标所需要的时间、胰岛素用量、低血糖发生率等情况。结果胰岛素泵组与胰岛素笔组相比,在血糖达标所需的时间、胰岛素用量及低血糖发生率方面差异有统计学意义（P〈0．01）,血清胴固醇、甘油三酯均有明显改善。结论胰岛素泵和胰岛素笔对2型糖尿病患者强化降糖调脂治疗均有效,且胰岛素泵降糖凋脂效果优于胰岛素笔。     

Comparison of fluvastatin + fenofibrate combination therapy and fluvastatin monotherapy in the treatment of combined hyperlipidemia, type 2 diabetes mellitus, and coronary heart disease: a 12-month, randomized, double-blind, controlled trial

BACKGROUND: Diabetes risk is often complicated by a mixed hyperlipoproteinemia not sufficiently controlled by a single antihyperlipidemic drug; however, there are some concerns about the safety of combined statin and fibrate treatments. OBJECTIVE: The aim of this study was to compare the efficacy and safety profile of fluvastatin + fenofibrate combination therapy and those of fluvastatin monotherapy in the treatment of combined hyperlipidemia, type 2 diabetes mellitus (DM), and coronary heart disease (CHD) (ie, high risk for cardiovascular disease [CVD]). METHODS: This 12-month, randomized, double-blind, controlled trial was conducted at the University of Pavia, Pavia, Italy. Patients aged 18 to 80 years with combined hyperlipidemia, type 2 DM, and CHD were randomly assigned to receive combination therapy with extended-release fluvastatin 80 mg + micronized fenofibrate 200 mg or monotherapy with extended-release fluvastatin 80 mg. All treatments were given in tablet form, once daily with the evening meal, for 12 months. Lipid variables (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol [TC], and triglycerides [TG]) at 6 and 12 months were the primary efficacy variables, and glycemic status (glycosylated hemoglobin [HbA(1c)], fasting plasma glucose, and postprandial plasma glucose levels) at 6 and 12 months was the secondary efficacy variable. Tolerability was assessed using physical examination, including vital-sign assessment, body-weight measurement, electrocardiography, adverse events, and laboratory tests. A pharmacoeconomic analysis of both treatment regimens was also carried out using the incremental cost-effectiveness ratio (ICER). RESULTS: A total of 48 patients (24 men, 24 women; mean [SD] age, 60 [5] years) were enrolled. After 6 months, all primary efficacy variables, except for TG level, showed significant improvements from baseline only in the combination-therapy group (changes: LDL-C, -25%; HDL-C, +12%; and TC, -19%; all, P < 0.05 vs baseline). After 12 months, lipid variables showed significant improvements over baseline in both groups (all, P < 0.05), except for TG in the monotherapy group. Significant changes in LDL-C, HDL-C, and TG were found in the combination-therapy group (-35%, +34%, -32%, respectively) versus the monotherapy group (-25%, +14%, -17%, respectively; all, P < 0.05 between groups). The change from baseline in HbA(1c) level was significant with combination therapy (-12% vs -7%; P < 0.05). Both treatments were well tolerated, with no significant differences in the incidences of adverse events between the 2 groups. The ICER showed that each 1% decrease in LDL-C level achieved with the fenofibrate + fluvastatin combination added a cost of 14.97 Euros/y (US 12.25 US dollars/y), and each 1% increase in HDL-C level added a cost of 7.48 Euros/y (6.12/y US dollars), over the cost of monotherapy. CONCLUSIONS: In this selected sample of patients with combined hyperlipidemia, type 2 DM, and CHD, the combination of extended-release fluvastatin + micronized fenofibrate was associated with a more improved lipid profile than fluvastatin monotherapy, and was a well-tolerated and cost-effective therapeutic choice to treat these patients at high risk for CVD.     

阻塞性睡眠呼吸暂停综合征伴血压升高患者血压、血糖及血脂控制情况

目的调查阻塞性睡眠呼吸暂停综合征(OSAS)伴血压升高患者在不同状态下血压、血糖、血脂控制情况。方法对57例OSAS合并高血压或正常高值患者的血压、血糖、血脂控制水平进行调查和随访,并与患者住院时的血压、血糖、血脂数值进行比较分析。同时对行腭咽成形术治疗的高血压患者手术前后的血压控制情况进行分析。结果 (1)高血压组调查时收缩压(SBP),舒张压(DBP)与住院时SBP及DBP相比明显降低(P<0.05);空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)调查时与住院时相比无差异(P>0.05)。(2)正常高值组调查时SBP、DBP、FBG、TC均较住院时增高(P<0.05);调查时TG与住院时相比无差异(P>0.05)。(3)合并高血压且行OSAS手术治疗的患者手术后SBP、DBP与手术前SBP、DBP比较明显降低(P<0.05)。结论 OSAS合并高血压患者出院后血压得到控制,但血糖和血脂有增高趋势;血压正常高值患者出院后血压、血糖、血脂均有增高趋势;OSAS伴高血压患者手术后血压水平得到改善。     

Clinical usefulness of doxazosin in patients with type 2 diabetes complicated by hypertension: effects on glucose and lipid metabolism

This uncontrolled study investigated the effects of using the alpha 1-blocker doxazosin (2 mg or 4 mg daily for 3 months) to treat 21 hypertensive patients with type 2 diabetes, including eight obese individuals (body mass index [BMI] > or = 25.0 kg/m2). A significant reduction in systolic and diastolic blood pressure, beginning after 1 month of treatment, was seen. There was no significant change in BMI. Although there was no obvious improvement in glucose metabolism, doxazosin treatment noticeably reduced insulin resistance and significantly lowered triglyceride and free fatty acid levels. No significant changes were found in total cholesterol, high- or low-density lipoprotein-cholesterol, atherosclerotic index, or small or large subfractions of low-density lipoprotein-cholesterol. None of the patients showed any adverse effects. The beneficial effects of doxazosin on blood pressure and lipid and glucose metabolism shown in this study suggest that this drug is clinically useful as an anti-hypertensive agent for patients with diabetes.     

两种药物联用对2型糖尿病患者IL-6血糖及血脂的影响

目的通过观察二甲双胍(MET)与罗格列酮(RSG)两种药物联用对2型糖尿病(T2DM)患者炎性反应因子白细胞介素-6(IL-6)、血糖及血脂表达的影响,探讨两种药物联用的临床意义。方法以仅服用MET的T2DM患者为对照组,40例;联合服用MET及RSG组为实验组,45例,疗程为3个月。分别测定受试者治疗前后空腹血清IL-6、血糖及血脂。结果与治疗前相比,各组患者空腹血清IL-6、血糖及血脂水平均明显降低,但实验组降低更明显,且实验组IL-6与对照组相比差异有统计学意义(P0.05)。结论联合应用MET与RSG可以明显降低T2DM患者的血清IL-6、空腹血糖、血脂水平,比独立应用MET更为有效。